重复经颅磁刺激联合西酞普兰治疗难治性强迫症随机对照研究

Research on Treating Refractory Obsessive Compulsive Disorder with Combination of Sitaplam and Repetitive Transcranial Magnetic Stimulation.

目的观察重复经颅磁刺激(rTMS)合并西酞普兰对难治性强迫症患者的疗效和不良反应。方法被试入组后随机分配到联合治疗组(rTMS+西酞普兰联合治疗)和药物治疗组(西酞普兰单独治疗)。西酞普兰治疗范围为20～60mg/d,起始剂量20mg/d,在2周内渐增至40～60mg/d。联合治疗组治疗时使用rTMS真刺激,刺激部位为右侧背外侧额叶,刺激频率为10HZ,刺激强度为100%运动阈值。药物治疗组治疗时使用rTMS伪刺激。观察疗效6周。采用Y-BOCS、汉密尔顿焦虑量表(HAMA)评定疗效,盲法评定。采用副反应量表(TESS)评价不良反应。结果联合治疗组基本痊愈5(14.71%)例,显著进步13(41.18%)例,好转7(23.53%)例,无效7(20.59%)例。药物治疗组基本痊愈2(6.45%)例,显著进步6(19.35%)例,好转11(35.48%)例,无效12(38.71%)例。两组疗效比较以联合治疗组较好(χ2=6.036,P=0.049)。两组治疗前Y-BOCS、汉密尔顿焦虑量表(HAMA)评分组间比较差异均无统计学意义(P均>0.05);两组治疗后各量表评分均显著下降(P均<0.01),以合用组下降更明显(P<0.05)。两组TESS评分比较在治疗2、4、6及8周末,差异均无统计学意义(P均>0.05)。结论右侧额叶背外侧rTMS刺激结合西酞普兰治疗难治性强迫症疗效优于单纯西酞普兰治疗。

Objective To explore the efficacy and side effect of repetitive transcranial magnetic stimulation（rTMS） combined sitaplam for patients with refractory obsessive-compulsive disorder（OCD）.Methods Patients were randomly assigned to combinced treatment group and drug treatment group,both groups received sitaplam treatment combined treatment group received rTMS,In rTMS treatments,the frequency was 10Hz and the intensity was 100% of motor threshold.Psychopathology was assessed by HAMA,Y-BOCS before the treatment,immediately after the experimental treatment,and 2,3,4,6,8 weeks after the experimental treatment by an independent reviewer.Results In combined treatment group,5（14.71%） cases remited,significantly advances 13（41.18%） cases,improved 7（23.53%） cases,invalid 7（20.59%） cases.In drug treatment group,2（6.45%） cases remited,significant improvement 6（19.35%） cases,improved 11（35.48%） cases,invalid 12（38.71%） cases.To compare the efficacy of two groups,the combined treatment group was better.（χ2=6.036,P=0.049）.The pre-treatment Y-BOCS,HAMA score differences between the two groups were not statistically significant（P0.05）;various scale scores of two groups after treatment of were significantly decreased（P0.01）,and combincd trcatmcnt group decreased more obvious（P0.05）.in the treatment of 2,4,6 and 8 of the weekend,there were no statistically significant differences between two groups in TESS score（P0.05）.Conclusion The right dorsolateral prefrontal rTMS combined situplam is better than staplam alone in the treatment of refractory obsessive-compulsive disorder.